POS1239 RISK FACTORS FOR SEVERE DISEASE COURSE IN MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C) – A MULTICENTER, RETROSPECTIVE STUDY
Authors: K. Kaidar, Y. Levinsky, R. Tal, L. Harel, G. Amarilyo
Journal: Annals of the Rheumatic Diseases (2022)

Background Multisystem Inflammatory Syndrome in Children (MIS- C) associated with COVID-19, presents as a cytokine storm with features of Kawasaki disease. Many cases present with shock and require intensive care admission. Objectives We aimed to identify predictors for severe clinical course of MIS-C as defined by the need for ionotropic support during admission Methods A retrospective multinational cohort study was conducted. Patients with a diagnosis of MIS-C from 9 Israeli medical centers and one US medical center (Chicago, IL) were included. Demographic, clinical, laboratory and imaging variables during admission and hospitalization were retrieved. Univariate and multivariate regression models were used to assess odds ratio (OR) of ionotropic support need during hospitalization. Results Overall 100 MIS-C patients were included in the study. Sixty-five patients (65%) were hypotensive, 44% required ionotropic support, and 37% had finding of Left ventricular dysfunction. Univariate model showed that LVD was associated with the need for ionotropic support (OR 4.178 [95%CI 1.760-9.917], while conjunctivitis (OR 0.403 [95%CI 0.173-0.938]) and mucosal changes (OR 0.333 [95%CI 0.119-0.931]) were protective. Laboratory markers for severe disease course were low hemoglobin levels, leukocyte count, thrombocyte count, lymphocyte count, neutrophils count, albumin and potassium, as well as high troponin and BNP. Conclusion Patients with MIS-c that present with a Kawasaki-like phenotype are less likely to require ionotropic support, while other clinical and laboratory parameters were found as risk factors and should be monitored during MIS-C hospitalization. References [1]Chiotos K., Bassiri H., Behrens E.M. multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: a case series. J Pediatric Infect Dis Soc. 2020;9(3):393–398. [2]Whittaker E, Bamford A, Kenny J, Kaforou M et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. 2020 Jul 21;324(3):259-269. [3]Feldstein L.R, Rose E.B, Horwitz S.M, et al. multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020 Jul 23;383(4):334-346. [4]Pouletty M, Borocco C, Ouldali N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis. 2020 Aug;79(8):999-1006 [5]Abrams JY, Oster ME, Godfred-Cato SE, et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Health. 2021 May;5(5):323-331. Table 1. and laboratory characteristics on admission of patients diagnosed with MIS-C w/o Hemodynamic supportN=56 (56.0%) with Hemodynamic supportN=44 (44.0%) p-value Gastrointestinal symptoms 46 (82.1%) 41 (93.2%) 0.103 Mucosal changes 18 (32.1%) 6 (13.6%) 0.031 Rash 34 (60.7%) 20 (45.5%) 0.129 Conjunctivitis 27 (48.2%) 12 (27.3%) 0.033 Extremity changes 4 (7.1%) 6 (13.6%) 0.280 Lymphadenopathy 11 (19.6%) 11 (25.0%) 0.521 No. of days of fever at admission 4 [3-5] 5 [3-5] 0.646 Systolic BP 99 [90-108] 97 [85-102] 0.263 Diastolic BP 60 [53-67] 53 [45-59] 0.006 HR 124 [114-143] 126 [108-144] 0.957 hemoglobin admission (g/dL) 11.65 [10.83-12.67] 11.25 [10.22-12.58] 0.220 White cells admission (K/µL) 9.02 [6.63-12.01] 9.03 [5.75-16.99] 0.742 platelets admission (K/µL) 174.0 [134.50-250.0] 147.50 [121.25-146.25] 0.126 lymphocytes admission (K/µL) 0.90 [0.64-1.70] 0.70 [0.48-1.11] 0.015 ESR admission (mm/hr) 43.00 [35.5-74.50] 44.00 [28.50-66.00] 0.575 C-reactive protein admission (mg/dL) 14.05 [10.32-22.28] 19.50 [10.90-27.30] 0.117 Creatinine admission (mg/dL) 0.55 [0.40-0.70] 0.69 [0.50-0.81] 0.008 Figure 1. - forest plot - clinical risk factors for need of hemodynamic support in MIS-C patients; Odds Ratio [95% CI] (univariate analysis) Disclosure of Interests None declared